To defeat Aids pandemic, save the children first

Monday April 26 2010

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By Peter Savosnick

As the Kenyan government struggles to find new ways to fund HIV/Aids treatment in the face of a Ksh16 billion ($21 million) shortfall, it is critical that prevention services are also scaled up and supported.

The Global Fund is not renewing financial support for the upcoming funding cycle, and Kenya is looking for creative ways to close the gap.

In addition, as recently reported in The EastAfrican, officials are reviewing HIV/Aids policies to reflect revised recommendations from the World Health Organisation that would put more people on treatment.

While ideas such as a tax on mobile phone airtime and public-private partnerships should be explored, it is critical that we commit to preventing new HIV infections, particularly in babies born to HIV-positive mothers.

Sixteen years ago, researchers proved that antiretroviral drugs are highly effective in preventing HIV infection in infants born to mothers living with HIV, which resulted in the near elimination of new paediatric HIV infections in the developed world.

Further research also showed that simple and inexpensive interventions with ARVs could dramatically reduce the risk of new infections in infants, even in settings such as rural Kenya where resources are limited.

The introduction of even more effective drug regimens has made it possible to prevent nearly every infection from mother-to-child.

However, today, more than half of HIV-positive pregnant women around the world still do not receive these services, and approximately 1,200 children are infected with HIV every day.

In Kenya, there are currently more than 150,000 children under the age of 15 living with HIV, most of whom became infected during pregnancy, childbirth or breastfeeding.

To date, our progress in fighting HIV in women and children has been incredibly promising. Five years ago, the global community reached just 15 per cent of HIV-positive women with prevention of mother-to-child transmission (PMTCT) services. By 2009, that number had increased to 45 per cent.

Some countries in sub-Saharan Africa are showing remarkable success. Botswana, Rwanda, and Swaziland, among others, have demonstrated that with political will, commitment of the health sector and adequate resources, care for HIV-positive pregnant women can be prioritised.

But what is also clear from these examples is that we need to do more, do it better, and do it faster. As indicated in the World Health Organisation HIV treatment and PMTCT recommendations, we need to identify and prioritise HIV-positive pregnant women to receive antiretroviral treatment, and start that treatment earlier.

We must also improve integration and co-ordination of HIV services within existing maternal and child health services if we are to dramatically impact maternal and child survival.

To achieve this, health systems must be strengthened and the work force capacity scaled-up. Most critical, however, is that we must have sustained high-level political commitment and increased resources for PMTCT services. We know we can stop the spread of HIV, particularly for children and infants — our challenge is to make these proven prevention methods available to everyone who needs them.

With the significant resources already going toward treatment in the fight against HIV/Aids, the only way to truly get in front of the pandemic is to prevent new infections.

It’s just too costly not to — both in shillings and in lives. With the promise of the elimination of paediatric HIV within our reach, this is one commitment we absolutely must keep.

Peter Savosnick is the country director in Kenya for the Elizabeth Glaser Paediatric Aids Foundation.